Health Indicator Report of Maternal Mortality

Why Is This Important?

Approximately 700 women die each year in the United States as a result of pregnancy or delivery complications (CDC). The death of a woman during pregnancy, at delivery, or after delivery is a tragedy for her family and for society as a whole.
Surveillance of maternal mortality identifies ways to improve the health, health behaviors, and health care of women before, during, and after pregnancy. Surveillance also identifies gaps in the health care system, social services, health care access, and the quality of prenatal and postnatal care.

Chart

The final determination about whether a death is categorized as pregnancy-related is made by the Utah Perinatal Mortality Review committee. Over time the composition of the committee and the information available has changed, affecting how deaths are categorized. The consensus of the committee and the current paradigm is that pregnancy profoundly affects mental health and substance abuse issues, leading those deaths to be categorized as pregnancy-related. Prior to 2015, the committee may have been less likely to categorize those deaths as pregnancy-related and this may have contributed to a rise in the pregnancy-related mortality rate in recent years. Because the total number of maternal deaths is very low, the change in categorization for even one death affects the mortality rate significantly.

Data Table

Pregnancy-Related Mortality Ratio, Utah and U.S., 1999-2016

Data Notes

Notes

Maternal death cases are identified in the following manner: all death certificates for women of childbearing years (ages 10-60) are identified. If the pregnancy checkbox is marked, there is a search for a linked fetal death and/or infant birth/death certificates within one year of the maternal death. A subset of all maternal deaths are categorized as "pregnancy-related" upon review by the Utah Perinatal Mortality Review Committee. [[br]]
[[br]]
The U.S. data shown here is from the CDC Pregnancy Mortality Surveillance System (PMSS), which summarizes and analyzes maternal death certificates and matching fetal death/birth certificates from 52 reporting areas. CDC data for U.S. maternal mortality for 2015 and 2016 are not yet available.
[https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pregnancy-mortality-surveillance-system.htm]
Widely quoted, higher estimates of U.S. maternal mortality were published in the Lancet in 2016.
Global, regional, and national levels of maternal mortality, 1990-2015. Kassebaum, et al.,Lancet. 2016 Oct 8;388 (10053):1775-1812.
[https://www.ncbi.nlm.nih.gov/pubmed/27733286]

Data Sources

Office of Vital Records and Statistics, Utah Department of Health

National Vital Statistics System, National Center for Health Statistics, U.S. Centers for Disease Control and Prevention

Data Interpretation Issues

The World Health Organization defines maternal death as the death of a woman while pregnant or within 42 days of termination of pregnancy, from a pregnancy-related cause. The CDC Perinatal Mortality Surveillance System and the state of Utah include pregnancy-related deaths during pregnancy and up to 365 days after the end of a pregnancy.
Care should be taken to clarify whether data are based on a 42 day or 365 day time period, and whether data refer to pregnancy-related deaths or pregnancy-associated but not related deaths.

Health Indicator Definition

Definition

'''Maternal mortality''' is a general term referring to the death of a woman during pregnancy or within a year of the end of pregnancy.
A '''pregnancy-related death''' is defined as the death of a woman during pregnancy or within one year of the end of pregnancy from a pregnancy complication, a chain of events initiated by pregnancy, or the aggravation of an unrelated condition by the physiologic effects of pregnancy. A '''pregnancy-associated, but not related death''' is the death of a woman during pregnancy or within one year of the end of pregnancy from a cause that is not related to pregnancy.
The '''pregnancy-related mortality ratio''' is the number of pregnancy-related deaths per 100,000 live births. ([http://www.reviewtoaction.org/learn/definitions])

Numerator

Number of women who died during pregnancy or within one year of pregnancy

Denominator

Total live births per year

Health Objectives and Targets

Healthy People Objective MICH-5:

Current Outlook

How Are We Doing?

The Utah pregnancy-related mortality ratio was 25.6 per 100,000 live births in 2015 and 25.7 per 100,000 live births in 2016.
The leading causes of pregnancy-related deaths in Utah in 2015-2016 were drug-related deaths and suicides.

How Do We Compare With the U.S.?

The Utah maternal mortality rate, although it has larger fluctuations, is trending along with the U.S. rate (see graph).
The U.S. maternal mortality rate has doubled in the past thirty years. Some of the increase is related to improved data collection, and some of the increase is believed to be associated with the increasing number of Cesarean deliveries, now one-third of all births in the United States. Also, there is now greater maternal mortality associated with heart disease and heart conditions than in previous years. Other chronic conditions such as hypertension and diabetes put a pregnant woman at higher risk of poor outcomes, and an increasing number of women in the U.S. have these conditions.

Health Improvement

What Is Being Done?

The Utah Department of Health conducts ongoing maternal and infant mortality surveillance through the Perinatal Mortality Review program. Public education is provided on the importance of planning for pregnancy, preconception and interconception health, and recognition and treatment of maternal depression. The Utah Women and Newborns Quality Collaborative (UWNQC) addresses issues of quality improvement in maternal and infant health care.

Evidence-based Practices

Utah collaborates with The Alliance for Innovation on Maternal Health (AIM) to promote consistent and safe maternity care. AIM has developed patient safety bundles, a package of evidence-based best practices for implementation by hospital obstetric units. Safety bundles address the leading causes of maternal mortality and are designed to reduce maternal deaths related to obstetrical complications.
In 2018, the Utah Department of Health hired a maternal mental health specialist, and established a Maternal Mental Health committee to promote evidence-based screening, referral, and treatment practices for maternal mental health disorders.

Available Services

Postpartum Support International-Utah provides extensive resources for maternal mental health. Visit their website at [https://www.psiutah.org/].
St. Mark's Hospital offers an intensive outpatient program for the treatment of perinatal mood disorders. More information is available at [https://stmarkshospital.com/service/perinatal-outpatient-program].
The University of Utah SUPRAD clinic specializes in care for pregnant women with substance addictions. Call 801-581-8425 for more information.
To find local substance use disorder and mental health treatment options, visit [https://dsamh.utah.gov].

Utah DOH

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